Peld Score as a Prognostic Factor in Fulminant Liver Failure Caused by Mushroom Poisoning in Children

Pop, Tudor Lucian; Grama, Alina; Stefanescu, Ana Maria; Delean, Dan; Aldea, Cornel; Bizo, Aurel

doi:10.1016/s0168-8278(16)00397-4

Cited by 5 publications

(4 citation statements)

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“…The mortality due to mushroom poisoning in our previous study was 51.68%, compared to only one case in the present study (16.67%), higher that in ALF due to drugs (6.89%). The prognostic factors for mortality in ALF due to mushroom poisoning were the presence of encephalopathy, acute kidney injury, and severity of liver injury at admission (high level of transaminases, bilirubin, and INR) [ 5 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Etiology and Outcome of Acute Liver Failure in Children—The Experience of a Single Tertiary Care Hospital from Romania

et al. 2020

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Background: Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. Knowing the possible cause of ALF plays a vital role in the management, as the child could benefit from effective specific therapies in emergencies. Methods: We have analyzed the etiology and outcome of ALF in children followed-up in a tertiary care hospital between January 2012–December 2018. The patients were grouped into different age categories: neonates (0–1 month), infants (1–12 months), children (1–14 years), and teenagers (14–18 years). Results: 97 children (46 males, 47.42%, the mean age of 7.66 ± 8.18 years) were admitted with ALF. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes (60% and 79.41%). The mortality rate was 31.95% (31 patients), mainly in ALF due to infections or metabolic disorders. Conclusions: In neonates and infants, the main causes of ALF were infections and metabolic diseases, while in older children and teenagers, were toxin-induced liver injuries. The mortality among neonates and infants was significantly higher than in other ages. Early recognition and immediate therapeutic intervention could improve the outcome of these patients.

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Section: Discussionmentioning

confidence: 99%

Etiology and Outcome of Acute Liver Failure in Children—The Experience of a Single Tertiary Care Hospital from Romania

et al. 2020

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“…In our previous works, in children mostly with ALF due to mushroom poisoning, serum creatinine and HE presence were found to predict mortality independently [75]. Moreover, in a study including 17 children with ALF due to mushroom poisoning, a PELD score over 20 had a 100% sensitivity and specificity to predict the fatal outcome, slightly better than KCC's 77.7% sensitivity and 100% specificity [76]. The present study, including a larger cohort of pediatric ALF patients, did not analyze mushroom poisoning separately because the number of patients with this cause of ALF decreased in the last years in our country [77].…”

Section: Discussionmentioning

confidence: 82%

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

Pop

Aldea

Delean

et al. 2022

JCM

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Objectives: In children, acute liver failure (ALF) is a severe condition with high mortality. As some patients need liver transplantation (LT), it is essential to predict the fatal evolution and to refer them early for LT if needed. Our study aimed to evaluate the prognostic criteria and scores for assessing the outcome in children with ALF. Methods: Data of 161 children with ALF (54.66% female, mean age 7.66 ± 6.18 years) were analyzed based on final evolution (32.91% with fatal evolution or LT) and etiology. We calculated on the first day of hospitalization the PELD score (109 children), MELD, and MELD-Na score (52 children), and King’s College Criteria (KCC) for all patients. The Nazer prognostic index and Wilson index for predicting mortality were calculated for nine patients with ALF in Wilson’s disease (WD). Results: PELD, MELD, and MELD-Na scores were significantly higher in patients with fatal evolution (21.04 ± 13.28 vs. 13.99 ± 10.07, p = 0.0023; 36.20 ± 19.51 vs. 20.08 ± 8.57, p < 0.0001; and 33.07 ± 8.29 vs. 20.08 ± 8.47, p < 0.0001, respectively). Moreover, age, bilirubin, albumin, INR, and hemoglobin significantly differed in children with fatal evolution. Function to etiology, PELD, MELD, MELD-Na, and KCC accurately predicted fatal evolution in toxic ALF (25.33 vs. 9.90, p = 0.0032; 37.29 vs. 18.79, p < 0.0001; 34.29 vs. 19.24, p = 0.0002, respectively; with positive predicting value 100%, negative predicting value 88.52%, and accuracy 89.23% for King’s College criteria). The Wilson index for predicting mortality had an excellent predictive strength (100% sensibility and specificity), better than the Nazer prognostic index. Conclusions: Prognostic scores may be used to predict the fatal evolution of ALF in children in correlation with other parameters or criteria. Early estimation of the outcome of ALF is essential, mainly in countries where emergency LT is problematic, as the transfer to a specialized center could be delayed, affecting survival chances.

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“…Various markers or scores are used to predict ALF outcomes. Extended prothrombin time (>50 s), low levels of plasma coagulation factors V and VII, cerebral oedema, severity of encephalopathy, sudden reduction in transaminases or liver size, high levels of α-fetoprotein (AFP), electrolyte disturbances, MELD and PELD scores and King's College criteria were studied as predictive factors for the evolution of ALF in children [4][5][6][9][10][11][23][24][25][26][27]. Clichy-Villejuif Criteria, with factor V levels as the main parameter, are used to decide the need for emergency liver transplant in ALF [5,[7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D-Binding Protein (Gc-Globulin) in Acute Liver Failure in Children

et al. 2020

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This study aimed to analyse vitamin D-binding protein (Gc-globulin) serum levels in acute liver failure (ALF) in children in relation to disease outcomes and correlations with other known markers used to evaluate the severity of ALF. Our study included 34 children (mean age 4.87 ± 5.30 years) with ALF of different causes (metabolic, 26.47%; autoimmune, 23.53%; toxic, 20.59%; infection, 17.65%; unknown, 11.76%) and 30 children without any liver injury (mean age 6.11 ± 4.26 years). The outcome was poor in 14 patients (41.18%), including one child with liver transplantation (2.94%). Serum Gc-globulin levels were significantly lower in ALF patients compared to the control group (151.57 ± 171.8 mg/L vs. 498.63 ± 252.50 mg/L; p < 0.000001), with an optimum cut-off of 163.5 mg/L (Area Under the Curve, AUC, 0.8921; sensitivity, 76.50%; specificity, 100%). Levels were also lower in patients with poor outcomes compared to survivors (59.34 ± 33.73 mg/L vs. 216.12 ± 199.69 mg/L; p < 0.0001), with an optimum cut-off 115 mg/L (AUC, 0.7642; sensitivity, 100%; specificity, 50%). Gc-globulin serum levels were variable according to ALF aetiology, i.e., lower in metabolic, infectious, or unknown causes compared to autoimmune and toxic causes. Gc-globulin serum levels were decreased in children with ALF and lower in those with poor outcomes compared with survivors. Gc-globulin serum levels were correlated with other known parameters used to evaluate the severity of ALF and could help to identify patients at high risk for poor outcomes.

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Peld Score as a Prognostic Factor in Fulminant Liver Failure Caused by Mushroom Poisoning in Children

Cited by 5 publications

References 0 publications

Etiology and Outcome of Acute Liver Failure in Children—The Experience of a Single Tertiary Care Hospital from Romania

Etiology and Outcome of Acute Liver Failure in Children—The Experience of a Single Tertiary Care Hospital from Romania

The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

Vitamin D-Binding Protein (Gc-Globulin) in Acute Liver Failure in Children

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